INTRODUCTION TO

CLINICAL PHARMACY
CLINICAL PHARMACY
A set of function that promotes SAFE, EFFECTIVE and
ECONOMICAL use of medications

Patient-centered and drug-oriented

A component of pharmaceutical care

PHARMACEUTICAL CARE

Direct, responsible provision of medication related care for

the purpose of achieving a definite outcome that improves a
patients quality of life

Involves the process through which a pharmacist cooperates

with a professional in designing, implementing and
monitoring a therapeutic plan that will produce specific
therapeutic outcome
CLINICAL PHARMACISTS

Ward Pharmacists

Involved in activities promoting the health of the patients

ROLES OF CLINICAL PHARMACISTS

Counseling

Drug Interactions

Research

Monitoring
DOCUMENTATION

Not documented, not done.

For tracking purposes, reference and evidence of work

Means of communication
PATIENT CHART
PATIENT CHART

A collection of documents that provides an account of each

episode in which a patient visited or sought treatment,
received care or a referral for care from a health care facility

A narrative or record of past events and circumstances that

are or may be relevant to a patient's current state of health
PATIENT CHART

A confidential record usually held by the facility and

information in it is released only to patient or with the
patients written permission

A collection of papers held in a folder but may be

computerized
1. PATIENT DEMOGRAPHICS

Patient Name
Age
Gender
Status
Address
Occupation
Religion
2. CHIEF COMPLAINT

A brief statement of the complaint or incident that prompted

medical consultation

Im having pain in my leg.

Sobrang sakit ng ulo
Laging nahihilo
3. HISTORY OF PRESENT ILLNESS

A detailed chronologic narrative, as much as possible in the

patients own words, of the development of the current
health problem from its onset to the present

He woke up at 7:15 AM and went to the bathroom to brush his

teeth. While walking from the bathroom to the kitchen, he noticed
general weakness and had trouble saying good morning to his
son. His son immediately brought him to the ER. While in the ER,
he started to have a right-sided facial droop.
4. PAST MEDICAL HISTORY

A narrative of prior illnesses, their treatments and sequelae

medical; surgical; obstetric/gynecologic; and psychiatric

3 years ago, Lucy was diagnosed as lupus carrier. Since the

diagnosis, Lucy has been taking Warfarin and she expects to
maintain Warfarin therapy for life. Her condition has
exacerbated a series of endotheliopathies, predisposing Lucy
to retinal microvascular occlusion.
5. FAMILY HISTORY

Present health or cause of death of parents, brothers, sisters,

with special attention to hereditary disorders

Documents presence or absence of specific illnesses in

family
6. SOCIAL HISTORY

Marital status
Past and Present Occupations
Travel
Hobbies
Stresses
Diet
Habits
Use of Tobacco, Alcohol or Drugs
7. MEDICATIONS, ALLERGIES,
IMMUNIZATIONS

List of any medications, both prescription drugs and over-

the-counter medications, home remedies, vitamins, and
supplements as well
8. REVIEW OF SYSTEMS

An exhaustive survey of symptoms or diseases, organized by

body system, not covered in previous parts of the history

A system-by-system review of body functions, organized and

complete examination of patients organ system as part of the
work-up plan when the patient is first seen by a physician

Gathered through verbal history or written check-off

questionnaire
9. PHYSICAL EXAMINATION

An evaluation of the body, and its functions using

INSPECTION, PALPATION, PERCUSSION and
AUSCULTATION

Actual visual and hands-on findings

10. LABORATORY TESTS

A generic term for any test regarded as having value in

assessing health or disease states
11. THE PROBLEM LIST

Any health care condition that requires diagnostic,

therapeutic or education action

Physicians assessment/Working diagnosis

List of all identified disease condition.

12. THE PLAN

List of physicians orders to address the problem list related

to the health of the patient
 SUBJECTIVE vs OBJECTIVE
Subjective Information that cannot be measured directly
and may not always be accurate or reproducible
(Demographics, History)

Objective Can be measured. They are observable and are

not influenced by emotion or prejudice (Vital signs)
 TYPES OF
MEDICATION ORDERS
 STANDING MEDICATIONS

Medications that are currently being taken by the patient in

accordance with the physician`s order
Medications to be given for more than one dose
PRN MEDICATIONS

Medications intended to be given when needed or provided with

condition
STAT MEDICATIONS
Medications that are given for a single dose immediately
IV Fluids/Incorporations/Parenterals

IV Fluids - Large volume parenteral administered continuously

to the patient
IV incorporations - Admixture of IV fluids and an additive
(usually electrolyte, vitamin, IV medication) administered
continuously to the patient
Parenteral nutrition - Nutritional formula that contains nutrient
such as glucose, amino acid, lipids and other added vitamin and
dietary minerals given intravenously
SINGLE ORDERS

Medication administered at once at specified time

Pre-medications in chemotherapy and surgery
COMMON DOSE
COMPUTATIONS
 PROBLEM

A physician prescribes Amiodarone HCl IV for a patient with ventricular

fibrillation. The prescribing information is:
Loading Infusions:
Rapid infusion over first 10 minutes 15 mg/min
Slow infusion over the next 6 hours 1 mg/min
Maintenance Infusion:
Slow infusion over the remaining 18 hours 0.5 mg/min
Amiodarone HCl IV is available in 3-mL ampules containing 50 mg/mL.
The pharmacist uses a 100-mL bag of D5W for the rapid infusion and 250-mL bottles
of D5W for the slow infusions.
 QUESTIONS

1) How many milliliters from an Amiodarone HCl IV ampule should

be placed in the 100-mL bag for the rapid infusion?
(see loading infusion rapid infusion over first 10 minutes)

Answer: 3mL Amiodarone HCl = one ampule

 QUESTIONS

1) How many milliliters from an Amiodarone HCl IV ampule should

be placed in the 100-mL bag for the rapid infusion?
(see loading infusion rapid infusion over first 10 minutes)

15mg/min x 10 min = 150 mg Amiodarone HCl needed for the rapid infusion

50mg/mL x 3mL/amp = 150 mg Amiodarone HCl in one ampule

Answer: 3mL Amiodarone HCl = one ampule

 QUESTIONS

2) What is the drug concentration in the rapid infusion,

in mg/mL?

Answer: 1.46 mg/mL

 QUESTIONS

2) What is the drug concentration in the rapid infusion,

in mg/mL?

150mg Amiodarone HCl in 103mL (100mL D5W + 3mL Amiodarone HCl)

150mg / 103mL = 1.46 mg/mL

 QUESTIONS

3) If the pharmacist added the contents of 3 ampules to each

250-mL bottle of D5W needed for the slow infusions,
calculate the drug concentration, in mg/mL.

Answer: 1.74 mg/mL

 QUESTIONS

3) If the pharmacist added the contents of 3 ampules to each

250-mL bottle of D5W needed for the slow infusions,
calculate the drug concentration, in mg/mL.

50mg/mL x 3mL/amp x 3 amps = 450 mg Amiodarone HCl

450 mg Amiodarone HCl in 259 mL (250 mL D5W + 9 mL Amiodarone HCl)

450mg / 259mL = 1.74 mg/mL

 QUESTIONS

4) What rate of administration, in mL/hr, should the pharmacist

recommend during the 6-hour infusion segment?
(see loading infusion slow infusion over the next 6 hours)

Answer: 34.5 mL/hr

 QUESTIONS

4) What rate of administration, in mL/hr, should the pharmacist

recommend during the 6-hour infusion segment?
(see loading infusion slow infusion over the next 6 hours)

1 mg/min x 1mL/1.74mg x 60min/1hr = 34.5 mLhr

 QUESTIONS

5) Calculate the rate of administration in (d) in drops/minute

with an administration set that delivers 15 drops/mL.

Answer: 8.6 drops/min

 QUESTIONS

5) Calculate the rate of administration in (d) in drops/minute

with an administration set that delivers 15 drops/mL.

34.5 mL/hr x 15 drops/mL x 1 hr/60 min = 8.6 drops/min

 QUESTIONS

6) Calculate the milligrams of drug administered by slow

infusion over the 6-hour segment.
(see loading infusion slow infusion over the next 6 hours)

Answer: 360mg
 QUESTIONS

6) Calculate the milligrams of drug administered by slow

infusion over the 6-hour segment.
(see loading infusion slow infusion over the next 6 hours)

1 mg/min x 60 min/hr x 6 hr = 360mg

 QUESTIONS

8) Make the same calculation as that in (7) but over the 18-hour
segment.
(see maintenance infusion slow infusion over the
remaining 18 hours)

Answer: 540mg
 QUESTIONS

8) Make the same calculation as that in (7) but over the 18-hour
segment.
(see maintenance infusion slow infusion over the
remaining 18 hours)

0.5 mg/min x 60 min/hr x 18 hr = 540mg

CASE ANALYSIS

Patient MN is a 3-year old child weighing 45 lbs. She was

ordered with Cefaclor (Xelent) 125mg orally every six
hours. According to lexi.com, Usual dose of children over
1 year is 25mg-100mg/kg/day in divided doses every 6-8
hours (max 4g/day)
CASE ANALYSIS

UNDERDOSE

Computation of daily dose of patient shows the prescribed

dose is lower than the minimum daily dose of Cefaclor.
(511.25mg to 2,045mg daily)

Refer to MD.
CASE ANALYSIS

Patient QR is a 68-year old male weighing 140 lbs. She

was diagnosed with infection and renal failure (serum
creatinine of 3.5mg/dL). He was ordered with
Cefotaxime (Claforan) 1g IV q8. According to lexi.com,
recommended dose of Cefotaxime for infections is 1-2g
IV q8.
CASE ANALYSIS
Recommended dose in Patient with renal failure:

Clcr 10-50 mL/minute:

Administer every 8-12 hours

Clcr <10ml/minute:
Administer every 24 hours
CASE ANALYSIS

Dose prescribed is within the doses recommended for renally

impaired impatients. (CrCl = 18.18mL/hr)

CrCl = (140-age [yrs]) x wt [kg] (x 0.85, if female)

72 x Creatinine [mg/dL]
CrCl = (140-68) x 140 lbs x 1kg/2.2lbs
72 x 3.5 mg/dL